Medicaid managed care

Hospitals, Others Oppose Easing Medicaid Access Requirements

Hospital groups and other health care interest organizations have expressed strong opposition to a Centers for Medicare & Medicaid Services proposal to ease requirements that states ensure adequate access to care for their Medicaid population. Under current federal Medicaid law, states must periodically review their Medicaid provider networks to ensure that Medicaid recipients have adequate access to care. Under a March CMS proposal, that requirement would exempt states from performing such reviews if at least 85 percent of their Medicaid population is enrolled in a managed care plan and similarly exempt them from reviewing the impact on their provider networks [...]

iqtsupport2018-06-01T06:00:07-04:00June 1, 2018|Medicaid, Medicaid managed care, Medicaid regulations|

A Look at Medicaid Managed Care

With 74 million people enrolled in Medicaid managed care plans – roughly 71 percent of the U.S. Medicaid population – the Health Affairs Blog has taken a broad look at Medicaid managed care, addressing the question of how it works, whether it’s working, and what its future may be. The two-part report notes that some Medicaid managed care companies are highly profitable and that this profitability has increased in recent years. It also notes that the manner in which these companies serve their members varies greatly, that their medical loss ratios vary considerably from state to state, and that the [...]

iqtsupport2018-05-08T06:00:00-04:00May 8, 2018|Medicaid, Medicaid managed care|

Medicaid is Toughest Insurer for Providers

Medicaid is the hardest insurer for providers when it comes to billing. Or so reports a new study published in the journal Health Affairs. According to this analysis, Medicaid claims take longer to file, are more likely to be rejected, more likely to be challenged, and take longer to be paid than Medicare and private insurance claims. While the biggest problem is Medicaid fee-for-service claims, even Medicaid managed care claims pose more problems than Medicare and private insurance claims. Learn more about the challenges providers face when working with Medicaid in the Health Affairs report “The Complexity Of Billing And [...]

iqtsupport2018-04-05T06:00:27-04:00April 5, 2018|Medicaid|

MACPAC Issues Annual Report, Recommendations to Congress

The Medicaid and CHIP Payment and Access Commission has published its annual report and recommendations to Congress. MACPAC’s report addresses three primary areas: Medicaid managed care, telehealth, and Medicaid disproportionate share payments (Medicaid DSH). With 80 percent of Medicaid beneficiaries now enrolled in managed care plans, MACPAC offers three major recommendations for improving Medicaid managed care efforts: permit states to require all of their Medicaid beneficiaries to enroll in a managed care plan extend Medicaid managed care section 1915(b) waivers from two to five years permit states to obtain waivers to waive freedom of choice and selective contracting restrictions MACPAC [...]

iqtsupport2018-03-20T06:00:31-04:00March 20, 2018|Medicaid, Medicaid managed care|

Study Looks at Medicaid and Managed Care

A new Commonwealth Fund study examines how managed care plans have tackled serving new members in Affordable Care Act-authorized Medicaid expansion states. According to the report, these managed care organizations have …focused on identifying and helping high-risk populations and addressing the social determinants of health. MCOs are testing value-based payment strategies that link payment with performance and are increasingly focused on engaging patients in their care. Leaders report common challenges: setting appropriate payment rates; managing members whose needs differ from traditional Medicaid beneficiaries; ensuring access to specialty care; and effectively implementing payment reform and practice transformation. Learn more about how [...]

iqtsupport2018-03-13T06:00:58-04:00March 13, 2018|Affordable Care Act, Medicaid, Medicaid managed care|

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met last week in Washington, D.C. to discuss a variety of Medicaid and Children’s Health Insurance Program issues. MACPAC, the non-partisan legislative branch agency that performs policy and data analysis and makes recommendations to Congress, the administration, and the states, addressed a number of issues during the meeting. Among them it discussed Medicaid managed long-term services and supports (MLTSS) and voted to recommend that states be given the opportunity to seek permission to make Medicaid beneficiary enrollment in managed care plans mandatory through revisions of their state plan amendment rather than by [...]

iqtsupport2018-01-30T06:00:58-05:00January 30, 2018|MACPAC, Medicaid, Medicaid long-term services and supports, Medicaid managed care|

MACPAC Meets

The non-partisan legislative branch agency that advises Congress, the administration, and the states on Medicaid and CHIP-related issues met recently in Washington, D.C. The following is the Medicaid and CHIP Payment and Access Commission’s own summary of its meeting. The December 2017 meeting of the Medicaid and CHIP Payment and Access Commission began with a brief update on the State Children’s Health Insurance Program (CHIP). Although federal funding for the CHIP expired at the end of September, legislation to renew funding was still pending in Congress. The Commission then heard from a panel discussing state tools to manage drug utilization [...]

iqtsupport2017-12-20T06:00:38-05:00December 20, 2017|Medicaid|

New Help With Addressing Low-Income Patients’ Social Services Needs?

One of the long-time barriers to states and hospitals addressing low-income patients’ social services needs and the social determinants of health has been a lack of resources for such assistance. Medicaid, in particular, has not been a financial participant in such efforts. But that may be changing. The new federal Medicaid managed care regulation, updated nearly two years ago, allows for the inclusion of some non-clinical services as covered Medicaid services and for funding for such services to be folded into Medicaid managed care plans’ capitation rates and medical loss ratios. The updated regulation also encourages greater coordination of care [...]

iqtsupport2017-12-04T06:00:13-05:00December 4, 2017|Medicaid|

New Rules Facilitate Integration of Physical, Behavioral Care

New federal regulations are facilitating better integration of physical and behavioral health services for the Medicaid population. Two developments, in particular, are advancing this integration: the 2016 Medicare managed care rule and a 2016 rule implementing the Mental Health Parity and Addiction Equity Act of 2008. Together, these rules encourage providers to perform comprehensive assessments of their patients, increase flexibility for providers in how they use Medicaid payments, and pave the way for improvements in the use of information technology that foster better integration of physical and behavioral medical care. A new issue brief from the Commonwealth Fund presents in [...]

iqtsupport2017-10-31T06:00:27-04:00October 31, 2017|Medicaid managed care, Medicaid regulations|

GAO: Improvement Needed in MLTSS Oversight

The Centers for Medicare & Medicaid Services needs to improve the job it does overseeing state Medicaid programs of managed long-term services and supports. According to a new report by the U.S. Government Accountability Office, 22 states use MLTSS programs to help qualified seniors continue living independently in the community and to save money on nursing home costs. CMS’s oversight of these efforts, and of the use of federal funds, is inconsistent and often falls short when monitoring key considerations such as provider network adequacy, critical incidents, and appeals and grievances. To address these concerns, the GAO recommends that CMS [...]

iqtsupport2017-09-21T06:00:37-04:00September 21, 2017|Medicaid, Medicaid long-term services and supports|